We provide a comprehensive service in reconstructive surgery. Mr Raj Ragoowansi, is acknowledged as an expert in his fields, and provides specialist opinions both within the UK National Health Service, and to private patients in the UK and overseas. He works in multidisciplinary teams where necessary, to achieve comprehensive total care, and maintains good links with the major insurance companies for issues of complex reimbursement, to allow our patients to concentrate on recovery.
In addition to general responsibilities in plastic surgery reconstruction Dr Ragoowansi delivers specialist care in the following areas of expertise:
- Hand surgery and upper limb reconstruction
- Bariatric (post weight loss) body recontouring
- Breast reconstruction
Soft Tissue Injuries - Face
With soft tissue injurie/ laceration it is advisable to have the wounds cleaned, irrigated thoroughly under LA. Following this manoeuvre, the wounds are then closed with dissolving sutures and a waterproof dressing applied. The preferred level of activity/mobility following the procedure is advised by Mr R on a patient/injury specific basis. At 7-10 days the waterproof dressing is removed (by the patient or by our clinical nurse specialist) and the wound is then exposed, and appropriate scar care, massage and topical silicone therapy given out. When outdoors, these scars are protected with sun protecting factor for 8-10 weeks following the procedure in order to ensure comfortable, subtle healing of the scars.
In certain patients, for example paediatric patients under the age of 10/11 years, if the wound is clean and deemed suitable for conservative management, then the wound edges are merely put together with steristrips and a further protective dressing applied on top. Adequate advice is given in terms of activities/ mobility in order to ensure that the dressings are kept clean, dry during the healing period of the wound. At 10 to 14 days post injury, the steristrips are removed by our clinical nurse specialist and advice is given on scar care, massage and topical silicone as above.
With certain scenarios, for example lacerations on the face/ forehead in young infants and children. Mr Ragoowansi prefers to have a lengthy discussion with the parents and paediatric nurse on the merits of operative vs non operative treatment of the wounds. This is primarily due to the fact that in very young patients these wounds can only be closed safely, comfortably under general anaesthetic and therefore the risks and benefits are adequately discussed with the parents (sometimes in conjunction with our anaesthetist) so that an informed decision as to the safest treatment is reached.
Our patients are reassured that our expert team of paediatric nurses, clinical plastic surgery specialists nurses and office staff are available at all times to provide advise/ information with regards to dressings, post-operative scar care and level of activity commensurate with the stage of healing is concerned.
Working with breast cancer surgeons, within the multidisciplinary environment including specialist breast nurses, we regularly undertake breast reconstruction, including partial and complex cases, using a wide range of contemporary techniques. Our breast reconstruction work is designed to suit the patient’s health, fitness and lifestyle, aiming for rapid recovery and maximal quality aesthetic results.
Hand Injuries – Soft Tissue & Skeletal
We offer a bespoke within and out of hours service to see and treat hand trauma.
Most of these injuries involve soft tissue only and require clean up, microscopic repair of underlying structures (tendon, artery, nerve) as appropriate followed by comfortable closure and a soft dressing to start early mobilisation. We then ask our hand therapist to change the dressing at day 5-7 after which period most manual activities can be carried out apart from lifting and carrying which is restricted for 2 weeks. If a tendon repair is carried out, a specific splint is applied and a program of activities are carried out within in for 4 weeks supervised by the hand therapist.
Tendon and artery repairs function straight away but nerve repairs do take up to 12-18 months to regenerate during which the hand/digit can suffer from pain, pins and needles and sensitivity.
If a fracture is repaired, internally (with screws and plates) or externally (K-wires) the hand/digit is rested in a splint and a graduate program of mobilisation is carried out by the hand therapist.
Hand Surgery & Limb Reconstruction
We provide a comprehensive hand, and upper and lower limb surgery service, with specialist physiotherapy backup and multidisciplinary operating where required. Within our hand team we manage all the common hand problems such as Dupuytren’s contracture, carpal tunnel syndrome and other nerve compression syndromes, wrist pain, abnormalities of hand posture, the rheumatoid hand, and hand trauma. We receive referrals for a complex limb reconstruction service using microsurgical and perforator flap based reconstructions for soft, supple, and stable results.
Ganglions are soft-tissue swellings and usually arise from the underlying joint capsule or tendon covering/sheath. They contain tick, gelatinous fluid, most commonly occur in women and present in young/middle age. The cause is unknown, but various theories hint towards a breach in the joint capsule with out-pouching of the joint capsule and its contents. They do not always precede trauma although are more common after repetitive activity. The most common sites are the back of the wrist, under the nail-folds and on the palmar surface of the fingers.
Due to their benign nature, the majority can be left alone unless they cause symptoms, restriction of movement or progressively increase in size. They can sometimes disappear spontaneously without any active treatment.
The dorsal (back of the wrist) wrist ganglions can be occasionally associated with an underlying weakness in the wrist joint (scapho-lunate joint) and therefore need careful clinical examination and an MRI. If superficial and not involving the joint, they can be left alone or aspirated. Surgery if indicated ( especially if they recur after aspiration), involves meticulous removal of the whole swelling together with repair of the underlying wrist ligament if necessary.
The volar ganglions ( front of the wrist) can either be left alone or removed in their entirety with careful, microscopic dissection to free them from the adjacent radial artery and branches of the radial nerve.
Ganglions under the nail folds ( mucous cysts) are indicative of underlying joint arthritis and again need careful removal with a limited synovectomy to free the joint of active, inflammatory, synovial tissue.
Flexor sheath ganglions can again be left alone if trouble-free or removed under microscopic control to ensure complete excision and careful preservation of the adjacent neuro-vascular structures.
In all of the above, post-operative hand therapy and massage with splintage for a short period is mandatory in order to minimise swelling and facilitate early, safe and comfortable return to activity.
Dupuytren’s Disease (DD) is a thickening of the deep tissues of the palm and digits and commonly affects the ring and little fingers. Thickening and tightening of these bands produces cord-like structures which tighten the palm and also pull the digits into flexion and inwards, into the palm. The cause is multi-factorial, primarily involving a genetic predisposition with contributory factors including trauma, certain occupations, excessive alcohol intake, anti-epileptic medication. The condition is progressive and treatment involves splintage, injections for early, localised disease and surgery for advanced disease.
Early assessment, intervention and close follow-up is recommended for a particular group of patients with high susceptibility. These include patients with the following features:
- Positive family history
- Onset of disease in young adulthood
- Disease involving both hands, especially if the disease involves the thumb and index finger
- Rapid progression of the contracture and hence functional compromise
- Presence of disease outside the palmar aspect of hand i.e. on the soles of the feet, on the genitals and also on the knuckles of the digits
At the initial consultation, a detailed examination to establish extent is carried out together with a comprehensive functional assessment of the degree of functional compromise. Treatment is tailored to stage of disease, symptoms and level of functional deficit and ranges from injection with steroids and local anaesthetic for pain-relief, enzymatic degradation of specific single cords in selected cases to surgical removal of the diseased cords using contemporary, minimally-invasive techniques to minimise discomfort, swelling and encourage early return to activity and work.
Follow-up clinics are scheduled to suit patient’s time and work commitments and hand exercises, splintage, ultrasound massage and lymphatic drainage e are carried out by expert, accredited therapists to ensure a comfortable and speedy recovery.
See & Treat Skin Lesions
Mr Ragoowansi routinely carries out excision of skin lesions under local anaesthetic in our minor operation suite at 101 Harley Street, London, W1G 6AH.
There procedures are either preformed on a day separate to the consultation day or on the same day (see & treat) should the need arise.
After informed consent, the appropriate lesion(s) is marked, and local anaesthetic injected with a fine needle just under the skin to create an area of anaesthesia. The lesion is excised and send for microscopic evaluation (if appropriate). The wound(s) are closed mainly with self-dissolving sutures through scars hidden in convenient, hidden creases to conceal the scar in the long term. A waterproof dressing is applied, and advice is given on activities such as driving, lifting, carrying and gym. You are allowed to shower over the waterproof dressings which are removed at a week following the procedure.
Thereafter, unless indicated otherwise, the dressings are removed by the patient and wound kept exposed. At day 10 following the procedure, advise is given on massage of the scar with simple moisturising cream followed by application of silicone gel and sun protection factor at 2 weeks following the procedure. This protocol of scar care and massage is followed for 8-10 weeks post-operatively in order to ensure smooth, comfortable healing of the scar.
At 10 days to 2 weeks the patient is invited back for a follow up review whereby he results of the biopsy are shared, the scar healing monitored and further advice given on scar care.